Dana-Farber research presented at 2016 ASCO conference

The 52nd Annual Meeting of the American Society of Clinical Oncology (ASCO) will include more than 70 research presentations by Dana-Farber Cancer Institute investigators and will attract as many as 30,000 oncology professionals from around the world. Held June 3 to 7 in Chicago at McCormick Place, presentations will cover the latest findings across oncology.

Here is a brief look at select studies Dana-Farber and Dana-Farber/Boston Children's Cancer and Blood Disorders Center researchers are presenting at the meeting:

Colorectal cancer: Tumor location impacts survival odds

Abstract 3505: Deborah Schrag, MD, MPH - Presenter

9:24 a.m. - 9:36 a.m.

Oral Abstract Session: Gastrointestinal (Colorectal) Cancer

Sunday, June 5, 8 a.m. - 11 a.m., Hall B1

Although the location of a colorectal cancer has a big influence on survival odds, this factor isn't routinely reported or included in patient counseling, say researchers from Dana-Farber who contend this practice needs to change.

In a study to be presented at the ASCO annual meeting, researchers found that the average survival of patients whose tumors were located in the right-hand portion of the colon, or large intestine, was about half that of individuals whose tumors were elsewhere in the colon.

The colon has a configuration like that of a large upside-down, square-sided "U" in the lower and upper abdomen. The ascending colon begins in the lower right abdomen and extends vertically. Then it takes a 90-degree turn straight across the abdomen to the left side. This portion is called the transverse colon. Taking another sharp turn, it becomes the descending colon, which goes down to the lower right abdomen, where it turns again to form the sigmoid colon, ending in the rectum and anus.

Using a federal database, the researchers compared median survival and three-year survival in patients with tumors on the right side (ascending colon), descending colon, and rectum. The patients had stage III or IV cancers.

Patients with tumors in the left side of the colon and the rectum survived for a median of 17 months, with a three-year survival probability of 27 percent.

Outcomes were significantly worse when the tumor was in the ascending colon on the right side or the transverse colon. Median survival in those patients was 8.7 months, and their odds of surviving three years were only 16 percent.

This disparity calls for consistent reporting in the medical record of the tumor's location, the researchers say, along with further research to determine why location influences survival.

Deborah Schrag, MD, MPH, an oncologist in the Gastrointestinal Treatment Center and chief of the Division of Population Sciences, Department of Medical Oncology, at Dana-Farber, is lead author of the study.

"We already understand that one reason for the difference in survival is that specific mutations such as BRAF are more common the right side," she said. "As more patients undergo genotyping, the mechanisms that underlie this finding will be better understood."

Even though the proportion of older patients with breast cancer participating in clinical trials after surgery has increased somewhat over the past 25 years, the proportion of older patients with metastatic breast cancer in presurgical trials is decreasing. In a study to be presented at the ASCO annual meeting, researchers found that overall, older patients with breast cancer are still largely underrepresented within these trials, research by investigators at Dana-Farber and City of Hope Comprehensive Cancer Center suggests. By examining the ages of patients enrolled in more than a dozen breast cancer trials between 1985 and 2012, the researchers found that the proportion of patients over age 65 - and in particular over age 70 - is not meaningfully improving with time, despite the fact that most breast cancers occur in these groups. The researchers, led by Rachel Freedman, MD, MPH, of the Susan F. Smith Center for Women's Cancers at Dana-Farber and Arti Hurria, MD, of City of Hope, call for the development of new accrual strategies to increase the participation of older patients.

Pediatric cancer: Survey finds strong support among clinicians for medical marijuana use in children with cancer

More than 90 percent of pediatric oncology providers favored access to medical marijuana for children and adolescents with cancer, according to a survey study to be presented at the ASCO annual meeting.

With more states legalizing medical marijuana, patients and families are asking providers to help them obtain marijuana products to try as treatments for nausea, pain, and loss of appetite. Nearly one-third of respondents to the survey reported receiving such requests more than once in the past month, according to lead researcher Prasanna Ananth, MD, MPH, pediatric oncologist, Dana-Farber/Boston Children's Cancer and Blood Disorders Center. Senior author is Joanne Wolfe, MD, MPH, director of the Pediatric Advanced Care Team, a joint pediatric palliative care program of Dana-Farber Cancer Institute and Boston Children's Hospital.

The study surveyed clinicians in Illinois, Massachusetts, and Washington, where medical marijuana is legal. Of 301 respondents, 92 percent favored helping pediatric cancer patients obtain medical marijuana. A majority - 88 percent - said using the drug near the end of life was appropriate, but only 34 percent would favor its use in early stage cancer treatment.

A marijuana-derived synthetic drug, dronabinol (Marinol) is routinely used in supportive cancer care to prevent or treat nausea and vomiting and to stimulate appetite. Patients anecdotally say medical marijuana, whether smoked or taken as an oil, is helpful for these problems, but its effectiveness hasn't been compared to dronabinol or other drugs taken to combat nausea, say the authors.

Ananth and Wolfe say they plan to conduct a second survey seeking opinions from adolescent and young adult patients and their parents about medical marijuana use.

Pediatric cancer: Many parents of children with cancer unaware of potential for long-term health problems, study finds

Today, the vast majority of children with cancer go on to become long-term survivors of the disease, but many survivors experience physical or cognitive impairments later on. A new survey to be presented at the ASCO annual meeting finds that most parents of survivors at high risk for such difficulties want detailed information about life after cancer but don't recognize the likelihood that their child will develop these problems. Investigators at Dana-Farber/Boston Children's Cancer and Blood Disorders Center surveyed 352 parents of children with cancer to assess how well they understood their children's risk of future limitations in physical abilities, intelligence, and quality of life. Among children identified by physicians as being at high risk for such challenges, 38 percent of parents recognized this risk in physical abilities, 21 percent in intelligence, and 5 percent in quality of life. The results indicate a need for better communication between doctors and parents about the risk of future health problems in survivors of childhood cancer, the investigators, led by Katie Greenzang, MD, pediatric oncologist, and Jennifer Mack, MD, MPH, pediatric oncologist and associate chief, Population Sciences for Pediatric Hematology/Oncology, both of Dana-Farber/Boston Children's, conclude.

Venclexta, the recently approved drug for hard-to-treat chronic lymphocytic leukemia (CLL) patients, has significant side effects, but they are manageable and often become less severe as treatment continues, according to a new study.

Venclexta (venetoclax) received Food and Drug Administration approval on April 11 for patients with CLL who have relapsed or not responded to at least one previous therapy, and whose cancer cells lack a piece of a chromosome called 17p. Patients with the 17p deletion have a worse prognosis.

The drug, which targets "survival proteins" cancer cells deploy to escape orders to self-destruct, has been hailed as a welcome new therapy for CLL after producing a high rate of responses, including some complete responses, in a phase 1 clinical trial reported in the New England Journal of Medicine (NEJM).

In a report to be presented at the annual meeting of the American Society of Clinical Oncology in Chicago, Matthew Davids, MD, MMSc, of Dana-Farber summarized Venclexta side effects and safety data on 279 patients, of whom 181 had the 17p chromosome deletion.

Of these, 24 stopped taking the drug because of adverse events, the most common being a low white blood cell count, diarrhea, nausea, anemia, fatigue, and upper respiratory tract infection. There were 11 deaths linked to adverse events. Tumor lysis syndrome (TLS), a complication of therapy where the rapid death of tumor cells causes metabolic disruptions, was observed in 5 patients, but all of these patients were able to safely reach the full dose and none discontinued drug due to TLS. Working closely with Abbvie and other investigators, Davids has helped develop precautionary measures that reduce the risk of life-threatening TLS.

Davids, a medical oncologist in the Division of Hematologic Malignancies at Dana-Farber, who was a leading investigator on the phase 1 first-in-human trial of Venclexta, says the results of the study are "reassuring, in that they look similar in this larger data set to the results we reported in the NEJM.

"One of the most interesting findings is that the rates of adverse events, particularly the hematologic and gastrointestinal toxicities, decrease significantly over time as patients continued on Venclexta. This suggests that the hematological toxicities, specifically, may be more related to prior chemotherapy and the CLL itself, rather than the drug, which over time helps these toxicities to resolve by effectively treating the CLL."

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